Raleigh, N.C. — Blue Cross Blue Shield of North Carolina said Monday that it would refund $155.8 million to 215,000 policyholders because of the national health reform effort.

Brad Wilson, chief executive of Blue Cross, the state's largest insurer, said the refunds would be issued by the end of the year to people who had individual Blue Advantage or Blue Options HSA policies on March 23, the date when President Barack Obama signed the Patient Protection and Affordable Care Act of 2010 into law.

"This is not necessarily in response to any criticism. It's simply the right thing to do," Wilson said. "A new law was enacted, new rules are in force, change is in the air."

Refunds will be equivalent to a little less than two months of premiums, meaning the average policyholder who pays a $380 monthly premium would receive about $690 back, he said.

"My initial reaction was to look out the window and see if any pigs were flying by. This is really amazing," said Adam Searing, director of the North Carolina Health Access Coalition and a frequent Blue Cross critic.

The one-time refunds are the result of new rating and grandfathering rules in the health reform law. Blue Cross will pay the refunds from reserves on the policies, Wilson said, noting deep reserves aren't needed because the policies will end in 2014 when the health care reform is fully enacted.

The state Department of Insurance also said Monday that it has approved a 5.37 percent rate increase to the Blue Advantage policies, which is lower than the 6.97 percent increase Blue Cross requested last month. Insurance Commissioner Wayne Goodwin said the lower increase – it's the lowest Blue Advantage increase in four years – would save policyholders $14.5 million.

The DOI approved Blue Cross' requested 2.06 percent rate increase for Blue Options HSA policies.